Provider Demographics
NPI:1275015778
Name:DINGS, PETRUS LEONARD (PT)
Entity Type:Individual
Prefix:
First Name:PETRUS
Middle Name:LEONARD
Last Name:DINGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:L
Other - Last Name:DINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2605 N LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 E WABASH ST STE 100
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-9400
Practice Address - Country:US
Practice Address - Phone:765-659-7400
Practice Address - Fax:765-659-7408
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003442A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023905Medicaid